Weight loss's link to better health questioned

We as a nation have put a lot of stock into the notion that being (or becoming) thin equates to better health and longer lives.

But some experts have called into question whether that connection -- or, conversely, the connection between overweight and poor health -- is all that strong, and even whether it exists at all.

One of the leading voices in the debate is Linda Bacon, associate nutritionist
in the University of California, Davis department of nutrition. Today she and a colleague, Lucy Aphramor, released a report in the online Nutrition Journal reviewing the key assumptions regarding the link between weight status and health. Citing findings from about 200 studies, they make a compelling case that overweight in and of itself does not pose a major health risk. (In fact, in some cases being overweight appears to reduce risk of certain diseases and conditions such as osteoporosis.)

Bacon's report suggests that changing eating and physical activity behaviors without regard for their effect on weight is more likely to improve our health, and that focusing on weight loss alone can have damaging consequences. For instance, "weight cycling," the all-too-common experience of repeatedly gaining and losing weight, can cause bodily inflammation, a risk factor for cardiovascular disease and cancer. Emphasis on weight loss can also inflict psychological and emotional stress, which can contribute to physical disease, the report notes.

Bacon repeats her observation that much health policy is built around the assumption that overweight causes such conditions as Type 2 diabetes and cardiovascular disease. In fact, she asserts (with supporting study references), evidence of cause-and-effect relationships between overweight and such health outcomes is scant:

While it is well established that obesity is associated with increased risk for
many diseases, causation is less well-established. Epidemiological studies rarely acknowledge factors like fitness, activity, nutrient intake, weight cycling or socioeconomic status when considering connections between weight and disease. Yet all play a role in determining health risk. When studies do control for these factors, increased risk of disease disappears or is significantly reduced. (This is less true at statistical extremes.) It is likely that these other factors increase disease risk at the same time they increase the risk of weight gain.

And there's this:

Except at statistical extremes, body mass index (BMI) -- or amount of body fat -- only weakly predicts longevity [32]. Most epidemiological studies find that people who are overweight or moderately obese live at least as long as normal weight people, and often longer.

I've interviewed Bacon before and reported on her "Health at Every Size" initiative several times. Her stance often meets with derision; it's hard for people to shake the belief that overweight is the root of many of our nation's health woes. But decades of dieting haven't paid off for Americans; twice as many of us are overweight or obese than otherwise, despite years of being told we need to slim down. Maybe it's time to look at the situation from a different perspective. Please take a few minutes to read Bacon's report and let me know what you think.

I don't dispute one of the primary conclusions of the report, "...that people who are overweight or moderately obese live at least as long as normal weight people, and often longer."

This may indeed be the case. But a long, miserable life isn't a goal worth pursuing. the goal. I wonder if the study sheds light on the variance in the appearance of recurring illnesses, and the relative quality of life, during the respective long lives of those who are overweight as opposed to those who are not.

I don't dispute one of the primary conclusions of the report, "...that people who are overweight or moderately obese live at least as long as normal weight people, and often longer."

This may indeed be the case. But a long, miserable life isn't a goal worth pursuing. the goal. I wonder if the study sheds light on the variance in the appearance of recurring illnesses, and the relative quality of life, during the respective long lives of those who are overweight as opposed to those who are not.

jerseboy,
I think all of us have different ideas of what a long miserable life is. I am a male 5' 10" and 164 lbs in good shape, and I hit the gym 5 day a week.
Some people would consider that a miserable life. I personally would rather die at 70 then live until 90 as a vegan or vegetarian because a world without meat would be a terrible, "miserable" life.

jerseyboy: Why in the world would you assume that people who are 'overweight' can only live miserable lives? Do you honestly not know ANY overweight people who are happy? I know many. And the more this society accepts the findings of the numerous studies that support "health at every size," the more we'll also have "happinness at every size."

I think the reference to a long, miserable life refers to some of the issues this study did not address. The stress on joints, the inability to move freely (being winded by stairs, short walks, being able to bend over to pick up something that you dropped) back pain, lack of flexibility. We might all have the same rate of death from heart attacks but some are living their lives without the restrictions that carrying 50 unneeded pounds around cause. The study didn't mention sleep apnea and all of the expenses related to it. I'm sure there are many more issues that I'm not thinking of at this moment ranging from daily discomfort to serious medical issues that must be treated at great expense. All of this is ignored here.

I do really like the mindful eating approach that the article recommends. That is great advice for everyone. I've started practicing it and I'm gradually getting better at it.

Being skinny doesn't mean that you're healthy or fit. What I got from the article isn't that it's okay to be fat, but that the emphasis on weight and not on eating healthy to ensure that you're meeting your nutritional requirements, and exercising so that you're fit, not thin, are what people should be doing. Focus on health and nutrition and you're better off. The idea that thin = beautiful helps drive anorexia and bulemia. Anorexics don't even realize that they are more likely to die from heart disease or heart failure, like the 'fat' people they don't want to emulate.

If the approach being used now actually worked American's wouldn't be getting bigger by the year.

I have no way to ascertain that you didn't reverse-engineer your position vis-a-vis being a meat eater to fit your disposition. Let's face it, if you found yourself in a society in which meat did not exist, somehow you'd survive. I really don't think you'd say you'd rather die and follow it up with action.

In our society: three weeks. That's how long it takes to replace an old habit with a new one. Smoking, eating... whatever.

jjj, I know overweight people who, in public, *pretend* to be happy. They even poke fun at their own weight. But that's a far cry from being dead cert that they are truly happy. Especially those in their late years. The overweight people I know in their sixties and seventies have a collection of medical problems––type II diabetes, gout, lower back pain, leg pain, etc.––related to being overweight. Happy or otherwise, they'd be even happier if they didn't have these chronic problems.

The argument for getting and staying fit isn't to be slim for the sake of being slim; it's to attain something called compressed morbidity. The idea is to be perfectly healthy, healthy, healthy into your seventies, eighties, nineties...until you contract pneumonia, and you die in two weeks. That's why one tries to stay fit. Not to live to be 100, but to live without doctors, pills, walkers and visits to the emergency room for the last fifteen years of one's life.

"three weeks. That's how long it takes to replace an old habit with a new one. Smoking, eating... whatever." Soooo not true. If that were true, everybody would go to Betty Ford for three weeks and come out fit as a fiddle.

Its hard to understand how excess weight (and not just extremes of weight) can be an important risk factor for innumerable diseases (cancer, cardiovascular disease, stroke, diabetes, renal disease to name but a few), and not decrease longevity. Many independent studies have confirmed the association between excess weight and disease susceptibility. Thus, one study that appears to dispute this might have to be viewed as suspect.

To all the tubs of lard out there - there should be a warning label at the grocery store: Food Kills.

Being fat causes inflammation in the body - and inflammation is the primary cause of most disease - like diabetes and heart disease. It also puts a much heavier load on all of your vital internal organs and all of your joints.

Go ahead and believe the health idiots at the Washington Post. It is real cool to be a tub of lard.

Here is how to be healthy: Stay optimistic, retain self-esteem and care enough about yourself to work toward a healthy weight that is relatively height/weight proportionate. Eat regular meals balanced with a variety of minimally-processed foods that are low in fat, salt and sugar. Get regular, quality sleep. Get regular exercise (30 min. of cardio, 3-5x/wk.). Stick with it. You will feel better and might lose weight if you need to. It really IS that simple.

The facts in the 2007 report, "Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity":

"Epidemiological studies show an increase in mortality associated with overweight and obesity. Individuals who are obese (BMI ≥ 30) have a 50 to 100 percent increased risk of premature death from all causes compared to individuals with a BMI in the range of 20 to 25...Overweight and obesity are associated with an increased risk for coronary heart disease; type 2 diabetes; endometrial, colon, postmenopausal breast, and other cancers; and certain musculoskeletal disorders, such as knee osteoarthritis." - NIH, 1998

"An estimated 300,000 deaths a year may be attributable to obesity." -JAMA, 1999

Here is how to be healthy: Stay optimistic, retain self-esteem and care enough about yourself to work toward a healthy weight that is relatively height/weight proportionate. Eat regular meals balanced with a variety of minimally-processed foods that are low in fat, salt and sugar. Get regular, quality sleep. Get regular exercise (30 min. of cardio, 3-5x/wk.). Stick with it. You will feel better and might lose weight if you need to. It really IS that simple.

The facts in the 2007 report, "Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity":

"Epidemiological studies show an increase in mortality associated with overweight and obesity. Individuals who are obese (BMI ≥ 30) have a 50 to 100 percent increased risk of premature death from all causes compared to individuals with a BMI in the range of 20 to 25...Overweight and obesity are associated with an increased risk for coronary heart disease; type 2 diabetes; endometrial, colon, postmenopausal breast, and other cancers; and certain musculoskeletal disorders, such as knee osteoarthritis." - NIH, 1998

"An estimated 300,000 deaths a year may be attributable to obesity." -JAMA, 1999

Some people would consider that a miserable life. I personally would rather die at 70 then live until 90 as a vegan or vegetarian because a world without meat would be a terrible, "miserable" life.
---

No, actually, it's not.

And I don't think hitting the gym 5 times a week is misery, either.

Sitting with a self-righteous bore who must atack others in a passive aggressive manner, well, that's kind of dull --.

LOL.

Anyway, life without meat is pretty easy, you don't even miss it, and after awhile, you wonder how others can eat the stuff, unexamined.

How is one a pet and one dinner -- I could never answer that question to my satisfation...

the article looks like a "scientific study" to promote the authors' business. the "journal" that published it deserves some inspection, as does it's "peer review" procedures. it's a garbage article and it's too bad wapo allowed itself to get sucked in by some self-promoters (though it's not surprising).
i would suggest that we need to engage in healthy behaviors and activities that improve the quality of life for ourselves and others. sometimes one's weight is a good measure of the effectiveness of our diet and exercise regime, but it's not the only one, and may or may not be the most important one. the atpiii study said that measurement of girth (abdominal fat) is the most accurate predictor of risk for heart attacks (i think that's what it said).

the nutrition journal publishes articles that it accepts for $2030. someone paid for this article to be published. if you're looking for good information try http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm
this is a 2004 report, but is being updated this spring and the update will be published this fall.

Dear alance: If calling people "tubs of lard" had any effect we'd all look like Size O supermodels. Should that be our goal or rather is it to be healthy, eat nutritious food, enjoy physical activity, and, we hope, be kind to those who find all that difficult. Being a slave to the BMI or the scale is NOT the goal; health is.

Bravo to the authors of the study for going against the grain. Remember cigarettes were once promoted as an alternative to weight loss, "Have a camel, not a candy."

In my experience--unless someone has had a real death scare-- people say they want to lose weight to be healthy, but they really want to look like the size 0 models. And they really think they can do it. A psychologist for the hyperbaric surgery center where I work says that huge people come in and present the magazine photo of the model/actor they think they will look like post-op. His job is to diminish those expectations.

Proper diet(generally lower fat and higher fiber) , exercise, and somewhere around 8 hours sleep per night is a good start for healthy living, but the regimen must be faithfully followed for the desired results. In other words, one needs to make it part of their lifestyle, and not part of a new years resolution.

Those of you dismissing this as 'only' a single and/or flawed study need to get better informed. There are now MANY studies that have found the same thing. It is, in fact, the studies that suggest a causal relationship between weight and health that are flawed (see Glenn Gaesser's "Big Fat Lies"). As for that "300,000 deaths" quote, if you look at the original study--which has been repeatedly and widely misrepresented--you will see that those deaths were attributed to unhealthy lifestyles. It had absolutely nothing to do with body size. Assuming that everyone who is 'overweight' is unhealthy is as ridiculous as assuming everyone who is 'thin' is healthy. Even more ridiculous: assuming that everyone who is 'overweight' and happy must be merely "pretending." The nonsensical notion that there is only one 'correct' size and shape for everyone to be has only caused harm. Much of what people believe about weight has nothing to do with reality and everything to do with stigma, prejudice, and the need to believe that others are somehow inferior to oneself. Open your mind a bit, read up, talk to experts, get informed: you will find out that everything I am saying here is supported by the facts. Doctors and others (sometimes with a bit of pushing) will admit that they know it IS possible to be 'fit and fat'--they're just afraid people can't 'handle' that information, neatly igoring the fact that the 'thin at any price' approach has only made things worse. Don't bother asking the diet industry--they're making $40 billion a year, why should they tell the truth?

I personally know someone who was not overweight until a non-curable disease set in and caused limited mobility. Now, of course everyone will say, "What a tub of lard; no wonder he is sick" and they don't even know the facts. And when he uses an electric cart, don't prejudge by saying "If he would walk, he would be better off." If he could walk, trust me, he would. I think this study is saying, maybe overweight is not the cause but possibly the effect. But of course I am sure all these healthy posters know better.

This is not the only study to question the widely accepted link between "overweight" and risk factors for various diseases. Reaad "The Obesity Myth" for more information.

It's about time this issue was discussed in the mainstream media. Simply being fat does not equate to diabetes, heart disease and the like. Being fat is often correlative -- that is, also present -- rather can causative.

Did any of you, particularly those who are critical, actually read the article?

The journal is a peer-reviewed journal with a large and diverse editorial board. The peer reviews are posted along with the article. Both reviewers for this article had no criticisms of the concept or the scholarship; they asked only for citations for a few points, which the authors provided in their revisions (also posted with the final version).

If your only contribution to this discussion is to talk about "tubs of lard," or to mention studies that the article casts doubt on, perhaps better you should sit this out. Or at least read the thing before you criticize.

I read the paper and some of the papers it references. In my opinion, a major shortcoming is in the use of BMI as a means of determining whether one is overweight. There are better measures of corpulence, but they have not generally been used by dieticians. BMI confuses muscle and fat, and it is not surprising that the resulting relationship between BMI and mortality is weak.

I read the paper and some of the papers it references. In my opinion, a major shortcoming is in the use of BMI as a means of determining whether one is overweight. There are better measures of corpulence, but they have not generally been used by dietitians. BMI confuses muscle and fat, and it is not surprising that the resulting relationship between BMI and mortality is weak.

I think people should weigh just about what the govt charts say they should. If you try to get down to "Hollywood weight" then if you do have an illness, I think you are more likely to die because you literally have nothing to lose. Conversely, studies have shown that pounds of fat actually excrete natural chemicals that are toxic when you have too much of them. This whole weight debate is about the culture of instant gratification. As Carrie Fisher said, "The trouble with instant gratification is that it is not quick enough." And so for a lot of people, food is the ultimate drug.

What a peice of garbage this report is. The report is absolutely unobjective. My grandfather would always say paper will lay still and you can write anything on it, and that is true of this paper. They make their argument and don't make the counterargument about the benefits of losing weight, which is the hallmark of a scientific paper. This paper is advertising.

I don't know about their claim about longevity but obesity creates a large number of physiologal and biomechanical problems that can't be addressed adequately by anything but losing weight. Look at the literature on abdominal circumference, not BMI. It is probably true that subcutaneous fat is bad as visceral fat.

As others have pointed out BMI is a terrible measure of body fat.

Now the question of once a person is obese how much it is practical for them to lose is a good question, most medical recommendations is losing about 10% of body weight is what people should achieve, but more is certainly desirable.

I hate agreeing with the study, but there's increasing research to support the idea that obesity isn't causative. It's something which makes my job as a fitness professional much more challenging. I've got clients who are obese, yet all the health markers are within norms according to the doctor.

What is apparent is that obesity may magnify risk factors all ready in place. Additionally, once you develop a health issue, the weight makes it much more difficult to get things controlled.

The cutting edge fitness professionals would LOVE to get clients focused less on weight as the measure of health and more focused on things like blood pressure, blood glucose levels, and overall mobility. Scale weight isn't the be all and end all.

I am just one pound into obese, which means I could get in the middle of healthy weight by losing about 50 pounds. The idea of me having joint pain, getting winded by anything other than a sprint, having back pain or trouble bending over, or suffering from sleep apnea is laughable. And I don't even exercise.

Point 2: Linda Bacon and the author of this article aren't saying that there's no correlation between obesity and health problems. They're saying that eating crap and being sedentary can cause both obesity and health problems. The obesity doesn't cause the health problems. If you eat right and exercise, you'll probably be healthy, even if you're still fat. If you eat poorly (unhealthy foods or too little food) and overexercise or underexercise, you'll probably be unhealthy, even if you're thin.

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